How to Help your Hospital Prevent Common Errors
Hospitals are not as safe as most perceive it to be. Really. Recent studies show than in most first world countries, the error rate is around 10%. Think of 10 friends or relatives who have been in hospital recently. One of these 10 people you know has very likely been involved in a preventable hospital error. Errors can result to no harm, to minor harm, to major harm or even death. In the US alone, it is estimated that 440,000 patients die annually as a result of a hospital error.
Here are some of the biggest problems facing hospitals across the world today, and here's how you as a patient, a carer, or a relative can help.
Prevention
The easiest way to prevent infections is hand washing. All hospital staff should be expected to wash their hands before and after they see you. Also if you have MRSA, VRE or any other infectious diseases, hospital staff should always wear appropriate protective equipment such as gowns, gloves and masks and dispose of them between each patient. When inserting a cannula, a technique known as aseptic non-touch technique should be used. This technique ensure that when a cannula is inserted, the risk of transferring germs are minimised. Prior to specific surgeries, to prevent surgical site infection, a preventative dose of antibiotic should be given.
How you can help
If you aren't sure if your doctor or nurse have washed their hands prior to seeing you, it is not impolite to ask them to wash their hands. After all, it impacts you to most. If you have visitors visiting, ask them to wash their hands before and after they see you too. If you know that you have an infectious disease, your visitors should also wear protective equipment. Ask your doctor if you will be needing a preventative dose of antibiotics before your surgery. Avoid touching your cannula and do not allow anyone to disconnect your lines and tubes of fluids.
Pressure injuries, also known as bed sores, is damage done to skin and sometimes tissue cause by constant pressure or friction. Older people are more susceptible to pressure injuries due to more fragile skin. In hospital, patients are at increased risk if they are less able to move, are in poor physical condition, are malnourished, obese and if they are smokers.
Prevention
On admission, a risk assessment should be undertaken to determine the risk of a pressure injury. Strategies to prevent if at risk include the use of special equipment like pressure injury preventing mattress, moving position regularly where possible, appropriate diet and skin care.
How you can help
Before your hospital admission try to maintain a healthy diet and if you smoke, try to quit smoking. During your hospital admission, discuss with your doctor or nurse when you can start moving around. Discuss with your doctor or nurse about your pain and how to best manage it. If you can, look at your own skin, if you see any redness or discoloration or pain, speak to your doctor or nurse about it.
Prevention
Strategies should be put in place to eliminate the use of confusing abbreviations. Where possible, an electronic medication chart should be used to eliminate handwriting issues. A good medication history and double checking with a second source should be obtained on admission to make sure all medication that a patient need is prescribed. Only one patient's medication should be prepared at a time to prevent mix up. Strategies should be put in place to ensure nurses have sufficient time in each shift to administer medication.
How you can help
Always keep a list of medications, vitamins and other supplements you take with you. An easy way to do so, is by storing it on your phone. If this is too confusing for you, ask your General Practitioner (Family doctor) to help write a list for you. Always make sure if the doctor is giving you new medication, to ask about it's side effects and what you should expect. If your nurse hasn't given you one of your regular medication, ask him/ her why.
Prevention
On admission, a falls risk assessment should be undertaken. This should then determine what the likely causes of falling are for you, and tailor the best possible preventative strategies. For example, if a patient has dementia and is physically week, beds should be put to the lowest possible setting to prevent them from any injury if they attempt to climb out of bed.
How you can help
If you're not sure you can move from your bed to the chair or the bathroom, always ask for help. Help is 1 buzz away. Use your walking aid when you have been recommended to use one. Turn on the light and use your glasses when you have to mobilise. Sit down to shower and always use the rails. Always put on your shoes or non-slip socks if you have to move out of your bed.
Hospitals are a 24/7 organisation. However, no staff should be expected to work 24/7. This means that it is highly likely in a single day there is more than 1 nurse or 1 doctor taking care of you. Staff are expected to hand over care formally to the incoming staff member. This goes the same if you get transferred from one ward to another. The art of communication is to be mastered, but unfortunately being human, it isn't rare that something gets missed along the way.
Prevention
Hospitals should have a standardised way of communicating hand overs. This means a structured way of communication together with an agreed time, place and who needs to be there at a hand over. A common communication structure is the ISBAR method (Identify, Situation, Background, Assessment and Recommendation). This aids staff in not missing important things to tell the incoming staff. Where possible hand overs should be done at bed side.
How you can help
Where hand overs are done at bed side, if you are well enough, pay attention to what the doctors and nurses are saying. If you don't understand something, it's okay to ask. If something that was said is factually incorrect, you should point it out to them. It's okay for your carer to participate in the hand over too.
Prevention
Hospitals should have in place a "Time Out" policy for all invasive treatment such as a surgery. In a "Time Out" all staff involved in the surgery should check that they have the correct patient, site and surgery immediately prior to having the surgery. Also for less invasive treatment, such as medication, staff should check with the patient or a second staff member their identity prior to giving medication.
How you can help
You should be an active participant of Time Out checks. If something is not right, you should say so immediately. Also, you should make sure your staff member check your identity prior to giving you medication, to prevent any possible error. If you think the staff member is giving you the wrong medication, you should also say so and not just swallow the pill down.
Prevention
Hospitals should have a system based on a patient's observations (such as blood pressure, temperature, heart rate, etc), a way of indicating to staff that a patient is deterioating. This should be linked up with a mandatory escalation system. This mandatory escalation system should also have a means where if a patient or a family member would want to escalate care, they can call for a doctor or nurse to come.
How you can help
If you think there's something wrong, or that something's wrong with your family member in hospital, do no hesitate and ask for a doctor or senior nurse to review you.
On the other hand, where working hours have been limited by labour laws, during "after hours" the most junior of staff are sometimes left to work under the supervision of someone slightly less junior. If you think of "after hours" being any time not 9 am - 5 pm Monday to Friday, "after hours" make up 76% of the week.
Prevention
Hospitals should ensure staff are well rested and work sensible number of hours each shift. Also, there must be adequate supervision of junior staff at all times, not just during during office hours. Hospitals should also ensure that there is good skill mix of staff so that even certain critical specialised tasks can be done during "after hours" where required.
How you can help
If you know that the hospital you attend are overworking their staff by making them work unsafe number of hours, you an try to advocate for the staff by being a consumer advisor. The other way of prompting change is by taking your care to a safer hospital, as this would force the management to rethink the way they get new customers. Also, you can volunteer at your local hospital.
References
Hospital Safety Score
Clinical Excellence Commission
Videos from Joint Commission - Speak Up
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To support my blog, please click on one of my sponsor's advertised links :)
1. Hospital acquired infections
One of the worst cases of hospital acquired infections in the developed world in 2015 is the Hepatitis C outbreak in on of Singapore's leading hospitals. The outbreak affected 25 patients, of whom 7 died as a direct consequence of the infection. Lesser known to the public, the most common forms of hospital acquired infections are through intravenous cannulas (more commonly known as drips), urinary cannulas and surgical site infections. These can lead to blood stream infections, also known as sepsis, which can be deadly.Prevention
The easiest way to prevent infections is hand washing. All hospital staff should be expected to wash their hands before and after they see you. Also if you have MRSA, VRE or any other infectious diseases, hospital staff should always wear appropriate protective equipment such as gowns, gloves and masks and dispose of them between each patient. When inserting a cannula, a technique known as aseptic non-touch technique should be used. This technique ensure that when a cannula is inserted, the risk of transferring germs are minimised. Prior to specific surgeries, to prevent surgical site infection, a preventative dose of antibiotic should be given.
How you can help
If you aren't sure if your doctor or nurse have washed their hands prior to seeing you, it is not impolite to ask them to wash their hands. After all, it impacts you to most. If you have visitors visiting, ask them to wash their hands before and after they see you too. If you know that you have an infectious disease, your visitors should also wear protective equipment. Ask your doctor if you will be needing a preventative dose of antibiotics before your surgery. Avoid touching your cannula and do not allow anyone to disconnect your lines and tubes of fluids.
2. Hospital acquired pressure injuries
Pressure injuries, also known as bed sores, is damage done to skin and sometimes tissue cause by constant pressure or friction. Older people are more susceptible to pressure injuries due to more fragile skin. In hospital, patients are at increased risk if they are less able to move, are in poor physical condition, are malnourished, obese and if they are smokers.Prevention
On admission, a risk assessment should be undertaken to determine the risk of a pressure injury. Strategies to prevent if at risk include the use of special equipment like pressure injury preventing mattress, moving position regularly where possible, appropriate diet and skin care.
How you can help
Before your hospital admission try to maintain a healthy diet and if you smoke, try to quit smoking. During your hospital admission, discuss with your doctor or nurse when you can start moving around. Discuss with your doctor or nurse about your pain and how to best manage it. If you can, look at your own skin, if you see any redness or discoloration or pain, speak to your doctor or nurse about it.
3. Medication errors
Medication errors in hospital range anything from missing a dose, giving the wrong dose or strength of the medication, giving the dose at the wrong time, double dosing to prescribing the wrong medication or strength, missing out a medication on the prescribing chart, to prescribing medicines which interact with each other and harming the patient. Medication errors can be compounded by poor handwriting or use of confusing abbreviations.
Prevention
Strategies should be put in place to eliminate the use of confusing abbreviations. Where possible, an electronic medication chart should be used to eliminate handwriting issues. A good medication history and double checking with a second source should be obtained on admission to make sure all medication that a patient need is prescribed. Only one patient's medication should be prepared at a time to prevent mix up. Strategies should be put in place to ensure nurses have sufficient time in each shift to administer medication.
How you can help
4. Falls causing Harm
As we get older, we are more and more likely to have a fall. While in hospital, this risk compounds with an unfamiliar setting or medication which cause drowsiness being given. Older people are not the only ones who fall in hospital. Children may fall out of beds or cots, particularly when parents are not paying attention. Women who have come to the hospital to give birth may fall especially when they are unsteady on their feet after an epidural or they have been simply exhausted after the birth.On admission, a falls risk assessment should be undertaken. This should then determine what the likely causes of falling are for you, and tailor the best possible preventative strategies. For example, if a patient has dementia and is physically week, beds should be put to the lowest possible setting to prevent them from any injury if they attempt to climb out of bed.
How you can help
If you're not sure you can move from your bed to the chair or the bathroom, always ask for help. Help is 1 buzz away. Use your walking aid when you have been recommended to use one. Turn on the light and use your glasses when you have to mobilise. Sit down to shower and always use the rails. Always put on your shoes or non-slip socks if you have to move out of your bed.
5. Miscommunication or Lack of communication
Hospitals are a 24/7 organisation. However, no staff should be expected to work 24/7. This means that it is highly likely in a single day there is more than 1 nurse or 1 doctor taking care of you. Staff are expected to hand over care formally to the incoming staff member. This goes the same if you get transferred from one ward to another. The art of communication is to be mastered, but unfortunately being human, it isn't rare that something gets missed along the way.Prevention
Hospitals should have a standardised way of communicating hand overs. This means a structured way of communication together with an agreed time, place and who needs to be there at a hand over. A common communication structure is the ISBAR method (Identify, Situation, Background, Assessment and Recommendation). This aids staff in not missing important things to tell the incoming staff. Where possible hand overs should be done at bed side.
How you can help
Where hand overs are done at bed side, if you are well enough, pay attention to what the doctors and nurses are saying. If you don't understand something, it's okay to ask. If something that was said is factually incorrect, you should point it out to them. It's okay for your carer to participate in the hand over too.
6. Getting mixed up
Getting a mix up between patients and the correct treatment can be a devastating error. This can come in the form of giving the wrong patient the wrong medicine, or even amputating the wrong limb. This problem is normally coupled with other confusing scenarios such as having two patients of the same name, twins, or having a row of patients having the similar surgeries.Prevention
Hospitals should have in place a "Time Out" policy for all invasive treatment such as a surgery. In a "Time Out" all staff involved in the surgery should check that they have the correct patient, site and surgery immediately prior to having the surgery. Also for less invasive treatment, such as medication, staff should check with the patient or a second staff member their identity prior to giving medication.
How you can help
You should be an active participant of Time Out checks. If something is not right, you should say so immediately. Also, you should make sure your staff member check your identity prior to giving you medication, to prevent any possible error. If you think the staff member is giving you the wrong medication, you should also say so and not just swallow the pill down.
7. Missing or not escalating the Deteriorating Patient
Patients in hospital have the potential of progressively getting sicker as part of their disease. Sometimes this deterioration gets missed and patients get much sicker than they need to be before they get treated. This can lead to an extended stay or a stay in intensive care costing either the patient, or tax payer a lot more money.Prevention
Hospitals should have a system based on a patient's observations (such as blood pressure, temperature, heart rate, etc), a way of indicating to staff that a patient is deterioating. This should be linked up with a mandatory escalation system. This mandatory escalation system should also have a means where if a patient or a family member would want to escalate care, they can call for a doctor or nurse to come.
How you can help
If you think there's something wrong, or that something's wrong with your family member in hospital, do no hesitate and ask for a doctor or senior nurse to review you.
8. Staffing issues
In some parts of the world, doctors and nurses are required to work for very extended hours. Sometimes this can be as long as 36 hours. This can be really frightening as almost anyone knows what can happen when one is way too tired to be working. I personally won't want a surgeon who has been working for more than 12 hours to be doing a procedure on me.On the other hand, where working hours have been limited by labour laws, during "after hours" the most junior of staff are sometimes left to work under the supervision of someone slightly less junior. If you think of "after hours" being any time not 9 am - 5 pm Monday to Friday, "after hours" make up 76% of the week.
Prevention
Hospitals should ensure staff are well rested and work sensible number of hours each shift. Also, there must be adequate supervision of junior staff at all times, not just during during office hours. Hospitals should also ensure that there is good skill mix of staff so that even certain critical specialised tasks can be done during "after hours" where required.
How you can help
If you know that the hospital you attend are overworking their staff by making them work unsafe number of hours, you an try to advocate for the staff by being a consumer advisor. The other way of prompting change is by taking your care to a safer hospital, as this would force the management to rethink the way they get new customers. Also, you can volunteer at your local hospital.
Conclusion
It's really important to speak up when you think something is going wrong. It's human to err. The vast majority of hospital staff go to work because they care to care. It's devastating for both patient and staff when an error is made. So, speak up and ask or tell if you think something if wrong as at the end of the day, your health matters.References
Hospital Safety Score
Clinical Excellence Commission
Videos from Joint Commission - Speak Up
To subscribe to my blog, please Like on our Facebook page.
To support my blog, please click on one of my sponsor's advertised links :)
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